BOOK REVIEWS

"1 would have men know, that, though I rcpreheRd the easie passing over of the cause* of thing! " by ascribing them to secret and hidden verturs and properties ; (for this hat(i arrested and laid, "asleepe all "true enquiry and indications;) yet I doe not understand but that, in the' practical ?'part of knowledge, much will be left to experience and probation, wiicreunto indication cannot " so fully reach : and this not only in specie, but in individuo. Yet it was well said, fere scire m esseper causa* scire."?BACON,

philosopher. The history of their progress daring the l^st three centuries displays, perhaps, the most afflicting series of calamities recorded in the annals of our art. Plagues and pestilence may have caused more extensive destruction of human existence ; but, if we trace the physical effects of those maladies through all their direct and devious courses, and then add to these the moral ills consequent on those illustrations of the sad truth, that ' ?' ? e medio de fonte leporum Surgit amari aliquid, quod in ipsis fioribus angat; it will be evident that they have been one of the greatest scourges the genius of Evil ever sent forth to desolate mankind. But* we rather choose to turn to the prospect opened to our view, and contemplate the happy change about to ensue from the ap-< plication of the true elements of medical logic to researches 01? the pathology and treatment of those diseases. We have aar ample scene for this in the work of Mr. Carmichael.
The author commences with a concise but lucid view of the'principal difficulties that have attended the investigation of the' nature of these diseases, and the most serious of the errors into* which pathologists have fallen in their mode of conducting their researches. We have, he says, been long taught to believe thatf inercury was the only remedy for every form of venereal disorder, gonorrhoea excepted. It was therefore time to commence the investigation, when every practitioner must have met with circumstances to shake his faith in the powers of the remedy, NO from perplexing embarrassments and inextricable difficulties accumulating upon him, as long as he persisted in the exhibition of this specific. But, he continues, " In order to preserve our faith unshaken, ingenious devices were sagaciously resorted to. By one of these we learned, that not only the new symptoms which arose under the most severe courses of mercury, but even the old ones which resisted its influence, were attribut-? able to the remedy and not to the disease. Hence we have descriptions of mercurial chancres, mercurial ulcers, pains, nodes, and swellings of the lymphatic glands of the neck. But, in ascribing those symptoms to mercury, we have entirely overlooked this obvious circumstance, that that medicine, when exhibited even to profusion for liver or anyi disease which is not venereal, has never in any one instance produced those effects." Mr. Carmichael is willing to allow that, on the occasions just mentioned, mercury, although it has not the power totally to supersede the actions of the morbific poison, may yet so far alter cJr modify its effects, as to change the appearance and natural progress of the disease. But this, he says, " is different from an admission that the remedy will produce symptoms which can scarcely be distinguished from those of the poison itself." This doctrine, although it is not satisfactory to the judgment, seems to be so far supported by observation as to lead us to consider it as a valid basis for our practical indications. It should be considered as a subject urgently requiring a new and particular investigation. But the most serious errors into which ive had fallen, are now to be noticed.
Another device, common to many arts and sciences besides surgery, is an endeavour to conceal our ignorance by the adoption of plausible and delusive epithets and appellations. The term syphiloidal 1 cannot but'regard in this point of view: it is usually applied to those symptoms which continue to linger after the patient has undergone full and repeated courses of mercury, and which that medicine ?was found incapable of curing. Those, therefore, who looked upon mercury as a certain cure for every form of venereal disease, found it necessary to give those unaccommodating symptoms a name: they therefore called them syphiloidal, which, if it means anything, insinuates that something is present which resembles or appertains to syphilis, and which is not syphilitic. The coinage of this name, however, gave them an opportunity of relinquishing the further use of ipercury, without making the mortifying acknowledgment that they had been using, to a dangerous extent, a medicine incapable of curing the disease for which it was exhibited. These subterfuges were however useful, and I will even say reflected some credit upon those who devised them, as they obviated the injurious perseverance in the use of the medicine, which might otherwise have been considered a matter of necessity. " Since, however, it is now well known that certain forms of vene-Mr. Carmichael's Observations on Venereal Diseases. 21 i real disease will pursue their course whether mercury is" employed or not, it is absurd any longer to retain words in our vocabulary, which ?are calculated to mislead us from the truth. Nothing, I am certain, would tend more to promote the present investigation, and the attainment of a perfect knowledge of venereal diseases, than to drop altogether those common but arbitrary terms, syphilitic, syphiloidal, and pseudo-syphilitic: even the term mercurial should be restricted to designate those phenomena only which are known to arise from the use of mercury in other diseases besides the venereal, by which means we avoid the perplexity of confounding the symptoms arising from the poison with the effects of the remedy.
In place of those arbitrary names, which mean nothing, if surgeons would confine themselves merely to terms descriptive of appearances and symptoms, language would not be wanting to convey au adequate notion of any class of diseases." Those sentiments are in conformity to the true principles of med cal logic, and will be acceded to by every person who is able to discern the means by which medical knowledge can alone be accurately acquired, and displayed with clearness and precision.
The distinctions which Mr. Carmichael has observed in the appearance and progress of certain groups of symptoms, which usually went together in diseases apparently arising from venereal congress, led him to presume the existence of a pleurality of poisons, which are propagated in this manner. The best pathologists seem to be well inclined to concur in this opinion, which is not only supported by daily observation, but also by fhe most authentic historical records. It seems hardly to admit of a doubt that animal poisons have been casually called into existence, that haye been diffused throughout whole nations by venereal congress, at various epochs; and we think the opinion of Dr. Weizmann, of Bucharest,* that these poisons have frequently originated on the connexion of different races of people, .merits particular attention. Literary records will probably not furnish the means of fully deciding this question, but, as far as our researches have hitherto extended., they powerfully support the opinion under consideration. We cannot in this place indulge in details on this subject, but we may observe in general, that, at different epochs since the eleventh century, alarms have been spread throughout one or more nations of Europe, by the progress of some dreadful ulcerative disease, obviously propagated by venereal intercourse. For instances : ?soon after the crusades, the dispersion of the Moors, the expulsion of the Jews from Spain, the discovery of America, the war in Canada. We may add, too, that many curious facts Whether or not Mr. Carmichael has precisely determined the number of the species of poisons ordinarily propagated by venereal intercourse at the present time in this country, is a question we cannot pretend to enter into the discussion of; but this is not cf much importance in the view in which he has re?garded these diseases, which we cannot too much approver His object is to determine the character, series, and order, of their symptoms ; and the appropriate measures for their cure, especially when mercury should, and when it should not,, be employed. This is a view of the subject which must be lully approved, even by those who consider that the varieties of character which Mr. Carmichael has distinguished, depend on per culiarity of constitution of the patient, not on a specific difference in the nature of the morbific poison.
Mr. Carmichael has, however, adduced evidence of the most powerful kind, although not sufficient to decide the question, to favour his distinctions of venereal diseases :? he says, We observe many primary nlcers evince, from their very commencement, such peculiar and distinct characters, that it would be quite an absurdity to believe that the virus is always the same, and the variety of characters dependent alone upon constitution. " Thus nothing can be more opposite, even from the commence, mcnt, than the common chancre with its hardened base, like a piece of cartilage under the skin, arid the sloughing ulcer. The first is slow and chronic; the latter begins with a mortified spot, extends by alternate sloughing and phagedenic ulceration, and makes more progress in three days than the former in as many weeks.* il The phagedenic ulcer is equally distinct from chancre, as it dotfs not evince at any period a hardened base, but gradually creeps from one part to another of the penis, leaving those parts to heal which ifi the first instance it attacked. So that,' when the disease has existed for some months, the glans is seen to exhibit its entire surface furrowed over with ulcerations and cicatrices. " There is a raised ulcer also with elevated edges, approaching the nature of the phagedenic ulcer, yet whose characters are sufficiently distinct to be considered as a separate species + But the most common ?venereal primary ulceration presents such various appearances in different individual/;, that, until a more exact knowledge is obtained, it is bctte,r described by its negative than its positive qualities; and it may be designated an ulcer without induration, raised edges, pr phagedenic surface. If the plurality of venereal poisons is supported by the variety of primary ulcers, it is equally so by the multiplicity of constitutional eruptions. A primary ulcer, which was not phagedenic or sloughing at first, may afterwards, like any other ulcer, become so by irritation, neglect, or inflammation. But I do not conceive that we have grounds for supposing that the state of the constitution can so modify morbid poisons, as to cause the same virus to produce in one person the chromic scaly lepra and psoriasis, and to assume in another a decided .pustular form, each pustule spreading rapidly into a deep ulcer.* u These two kinds of eruption may serve to illustrate the subject, as in their nature they are so directly at variance. But I would be inclined to admit, that an eruption of papula: with acuminated heads containing matter, and approaching the pustular form, might be so affected by the constitution as not to be distinguishable from the most Tegular pustules. The character of the disease may however still be apparent, as their pustules, instead of spreading into extensive ulcers, will, like papulae, terminate in desquamation; but the scales will be larger; and, in addition to this circumstance, the pustules will through, out be intermingled with papulae. These circumstances may serve to distinguish, in doubtful cases, the form of disease which is attended by the venereal lichen or papular eruption, from that which is much more formidable, and produces pustules which end in obstinate ulcers, that spread at their circumference by a phagedenic edge, and heal from their centre." Pursuing the investigation of the progress of these diseases, Mr. Carmichael found that each of the species of primary ulcer above described was followed by a certain and peculiar order of secondary symptoms; and in the following manner: " First.?That the syphilitic chancre is attended by the scaly eruptions lepra and psoriasis, an excavated ulcer of the tonsils, and pains and nodes of the bones. 44 Second.?That the ulcer without induration, raised edges, or phagedenic surface, gonorrhoea virulenta, and excoration of the glairs and prepuce, are followed by a papular eruption, which ends in desquamation, pains in the joints resembling those of rheumatism, sore-Jiess of the fauces, and frequently swelling of the lymphatic glands of the neck ; but that, in a vast number, not a single instance was ob* served in which nodes were an attendant upon this eruption. " Third.?That the ulcer with elevated edges, in the few instances in which I had an opportunity of tracing it to its constitutional symptoms, was followed by a pustular eruption, which terminated in mild ulcers, pains in the joints, and ulcers in the throat, but no appearance of nodes; yet that the instances in which I had an opportunity of witnessing distinctly the connexion between the primary and secondary * " Tlie reader may compare the different species of eruptions delineated in the plates of my former Essays; but particularly l?t him compare the scaly chromic syphilitic eruption in plate i. with the acute pustular eruption in plate jv. These forms of eruptiou arc its dissimilar iu their progress as they are in their appearance.
? 214 Critical Analysis. # symptoms of this poison, were too few to form any conclusion with respect to this particular. " Fourth, and lastly.?That the phagedenic and sloughing ulcers are generally attended by constitutional symptoms of peculiar obsti* nacy and malignancy ; viz. pustular spots and tubercles, which formed ulcers that spread in general with a phagedenic edge, and heal from the centre.
Extensive ulceration of the fauces, particularly of the back of the pharynx; obstinate pains of the knees and other joints ; while nodes are frequently present, and the bones of the nose are oc? casionally affected." After passing in review the opinions of Mr. Rose, Mr. Guthrie, Dr. Thomson, and Mr. Hennen, respecting the cure of the syphilitic species of disease without mercury, the author relates the results of his own experience. We may now pass over this part of the work, since it engaged our attention on a former occasion, (see vol. xli. p. 60 et seq.) to the chapter on Iritis.
In his former e&ay on Venereal Diseases, Mr. Carmichael expressed himself disposed to consider venereal iritis as a consequence of the poison of syphilis, or that which occasions the chancre (of John Hunter) and the scaly eruption, because he had always seen it yield quickly to mercury, and he had not then seen this affection accompanied with any eruption. Since that period he has met with many cases of this combination of symptoms, and, with one exception, the eruption was always papular: of this, several cases are adduced. These observations are particularly interesting; they serve to elucidate an obscurity in the history of iritis, which so much embarrassed Mr. T havers in his researches into the nature and cure of this affection. We cannot follow the author through all his judicious and highly valuable reflections on this subject; but, by way of summary, it may be stated, that it appears, from Mr.
Carmichael's observations, that iritis is a symptom of the disease attended with the papular eruption, which disease will run its course in spite of the use of mercury, although some of its symptoms may be removed by that remedy; that it will occur ?with the papular eruption, when no mercury has been used; that it will happen without the presence of any eruption ; and that, in either case, the use of mercury, although not essentially necessary for its cure, will be beneficial in conjunction with antiphlogistic measures, by assisting in removing the inflammatory action, and by preventing its disorganizing effects.
The subject or the next chapter, the phagedenic ulcer, is the Mr. Carmichael's Observations on Venereal Diseases, 215 " The origin of this from a peculiar species of morbific poison,has been disputed by some pathologists. They consider its {phagedenic character to depend on the state of the constitution of the patient; and state, they have observed many cases of venereal ulcer, of the ordinary character on their first appearance, which have subsequently assumed all the characters of the ulcer designated by Mr. Carmichael as the primary phagedenic ulcer, and which have also been followed by the eruption he considers peculiar to that species of primary affection. This objection has been expressly made by Mr. Guthrie. This is an important * objection, because, what forms the most powerful evidence of the propriety of Mr. Carmichael's distinctions, is the constant and regular connexion of the primary and secondary symptoms which he has described. In reply to this, the author states, thatin every instance where he has had an opportunity of tracing the constitutional symptoms to the primary ulcer, this ulcer has always exhibited the phagedenic character; and it should be observed, that Mr. Guthrie acknowledges that the ulcers he refers to became afterwards phagedenic.
There is much difficulty attendant on the investigation of this question, which, as Mr. Carmichael readily acknowledges, requires further observations to enable us to come to a decision. These ulcers, he remarks, are not often seen in their firststage, generally not till some days, or even weeks, have elapsed, ill consequence of the little uneasiness they then occasion j and to this must be added the fact, that various accidental causes will make any species of ulcer become phagedenic. The constitutional symptoms that Mr. Carmichael has seen ensue from ulcers of the latter kind, have however been of a mild character, and readily admit of cure ; whilst those that have occurred after the primary phagedenic ulcer are always of a formidable character, and long and difficult of cure.
We, on a former occasion, mentioned that Mr. Carmichael had some doubts respecting the power of mercury to prevent constitutional affection from the syphilitic primary ulcer ; he is still less disposed to place confidence in the efficacy of that medicine to prevent the constitutional symptoms of the phagedenic disease. He does not absolutely protest against its use; but, if it be employed, it should not be resorted to until the primary ulcer is perfectly healed. It is decidedly injurious in all cases in the primary affection. This latter point is generally agreed on by experienced surgeons; and wine, bark, and opium, are the remedies on which they have usually placed their reliance, until its phagedenic character has disappeared, and the ulcer, if not quite, at least very nearly, liealed. Mr. Carmichael places most reliance on the efficacy of copious blood-letting ifi the treatment of this disease. He has frequently seen cases l 216 Critical Analysis* where the ulcers spread rapidly under the use of the remedies we have mentioned, but ceased their ravages on the occurrence * of a spontaneous or artificial haemorrhage. With this he has usually conjoined antimonials, purgatives, cicuta, and opium. Warm fomentations and bread-poultices, frequently witn the addition of opium, are recommended, as local applications. In every instance, low diet and the recumbent position should be strictly enjoined.
We now enter on the consideration of the secondary symptoms, which the author considers to be peculiar to the species of primary ulcer just described.
The eruption is frequently ushered in by a high degree of fever, and it " quickly passes into ulcers covered with thick crusts, that heal from the centre, whilst they are extending at the circumference with a phagedenic border." To this description we shall add some particular observations that our own experience has afforded, which we think may be useful to the young practitioner, in assisting him to form the diagnosis of 218 Critical Analysis. The synopsis of the pathology and treatment of venereal diseases according to the doctrines of Mr. Carmichael, (which is transcribed in another part of this Journal,) will furnish a general account of his precepts for the treatment of the constitutional symptoms of the phagedenic malady. We shall here only observe, that mercury is of but occasional and partial utility; is more frequently deleterious than beneficial; although it some-, times alleviates some of the symptoms, it will not check the progress of the disease; and new symptoms commonly appear, when the system has been long under the influence of that medicine.
This disease in many respects resembles yaws; and the author refers to the work of Dr. Adams on Morbid Poisons, for some interesting facts aud valuable observations illustrative of this resemblance. ' ?
We cannot follow the author through all his reflections on the rtiode of treating the different forms of this disease; they can only be contemplated with all the benefit they are calculated to produce, in connexion with the cases which accompany them, which serve as illustrations. We must also remark, that the value of the doctrine contained in this work is much increased by a view of it which now forcibly presents itself. The author has methodically illustrated his principal points of theory by ap? propriate cases, which render his descriptions perspicuous, and at the same time show the bases on-which they are raised. The diseases of a less-distinctly marked character, though resembling in some respects the phagedenic malady, is next considered. On this subject we do not find many observations of important novelty, after the history Mr. Abernethy has given of those affections.
This work concludes with some critical remarks on the opi>? nions of Mr. Charles Bell respecting the nature and treat* ment of venereal diseases.
-> From the account we have given of this treatise, it must, we think, be evident that it is calculated to be productive of much benefit to medical science. Although the pathological distinctions the author has formed of the diseases that form the subject of it should not prove to be precisely correct^ a question which remains to be decided by further experience, his accurate and perspicuous histories of those affections will not be the l,ess valuable, either in a nosographical or therapeutical point of view: all other objects are of tar inferior importance. The true principles of medical logic which have guided the author's researches, and the methodic manner in which he has displayed the results of his labours, may serve as a model to those who may pontinue the investigation of the history of the same ladies. London. 8vo. pp. 213. 1818. " Nisi saiiatus animus sit, quod sine philosophla fieri nou potest, finem miscriarum nullum fore."?CICERO.
" The cloud of darkness and uncertainty which still, unfortunately," says the author, 4< pervades this department of medical science, is deeply to be lamented. An extraordinary neglect on the part of ph}'sicians of due attention to the subject of insanity, bespeaks a supineness for which there cannot be any admissible excuse." We acknowledge the truth of the sentiment expressed in the first of the foregoing sentences, and shall have occasion, before we have concluded our review of this work, to notice some of the most powerful of the obstacles which have prevented the elucidation of the nature of this malady. But, that insanity has been neglected by physicians of modern ages, is not so evident. They have in general devoted as much attention to this subject as could be thus beneficially applied. The nature of the affection, from which the patients of it are ordinarily collected into particular receptacles under the superintendance of a few individuals, must however deprive the generality of physicians of the means for making original observations ; but, that those who have possessed this advantage have not failed to employ it in a proper manner,, is so clearly shown by the medical literature of Europe, as to render a formal demonstration of it unnecessary.
We pass over the rest of the introduction, since it contains nothing worthy of remark, except some erroneous doctrine rer specting " mental insanity," that we shall not meet, with more fully displayed, in the author's " pathological division of insanity." Dr. Hallaran commences this subject with stating that " A principal object of this treatise is, to point out the practical distinction between that species of insanity which can evidently, ab initio, be referred to mental causes, and may therefore be denominated mental insanity, and that particular excitement, which, though partaking of like effects, so far as the sensorium is engaged, might yet appear to owe its origin merely to organic disease. Authors on this subject seem, heretofore, to hare passed over this necessary consideration." The principal object of this treatise is, then, to advance a point of doctrine, which has not been excelled in absurdity by any of the chimerical dogmas that error has in any age intro-2 F S> 220 Critical Analysis. duced into medical reasoning. The invention of such a doctrine a few centuries since, when almost every branch of science was" cultivated on erroneous principles, cannot excite our surprise; but it does this, to find it brought forward at a period when the influence of the works of Bacon, of Locke, and of Condillac, is generally diffused amongst men engaged in the pursuit of science. Bacon teaches us, that the only knowledge we can acquire of nature, is the history of phenomena evident to our senses ; ar.d the metaphysical principles of Locke and Condill&c, principles acquired in the mode inculcated by Bacon, declare the notions advanced by Dr. Hallaran respecting the human mind to be utterly erroneous. This is the conclusion our best principles of metaphysics lead us to form respecting the proposition, that intellectual insanity can exist independant on corporeal disorder. But let us examine the subject in a physiological point of view ; or rather, the arguments of this nature produced lay Dr. Hallaran to support what he pleases to con* sider as his own original doctrine. We shall not enter into a general discussion of it, because it is of a very ancient date, and is now, we believe, almost universally abandoned. As far as we can learn from literary records, it was first adduced by Plato, (see his Timaus and Theatetus ;) but the Grecian physicians, cultivating physiology on the principles of Hippocrates, would not admit it: it was again brought forward when the philosophy of Des Cartes, or rather of Pereyra, came into vogue ; and was finally extensively displayed by Dr? Arnold, in his treatise on Insanity. These observations will serve as our apology for not entering into a regular discussion of this subject. .

1
The author, as his first argument, says, ** I would advert to the many well-authenticated instances of in.
sanity, as they have occurred within the last twenty-five years espeL cially, and are noted on the records of our lunatic asylum. Amongst those are several which have owed their origin to mental causes, strictly speaking,?such as dread of punishment, loss of friends, shame, sudden terror, remorse, &c." Every physiologist knows (it is proved by dissection) that dread, terror, remorse, and all the passions, are accompanied with inordinate cerebral actions; and Locke teaches us, that these inordinate actions only arise, either immediately from the impressions ot external objects on the organs of sense, (to which modern physiologists are disposed to add those from the ?\iscera, &c. but this does not alter the question in dispute;) or, subsequently, from the same actions being reproduced by the agency or memory. Dread, grief, shame, terror, remorse, &c. anq consequences, are then essentially dependant on corporeal disorder. Permanent or remittent insanity is sometimes Dr. Hallaran on the Causes and Cure of Insanity. 22 i the result, because those causes may induce either functional or organic lesion.' The author stgain says, u The influence of terror on the human mind suddenly induces uncontrollable madness, without seeming to disturb any of the principal organs of vitality." We have never seen a case of this kind, and we do not think there is another physician in existence who believes that it can possibly happen. If l)r. Hallaran will say that he has seen instances of it, we will say that he has seen inaccurately. But let us proceed: Dr. Hallaran says, (< I cannot question the immateriality of the mind or soul; but I will not deny that the mind or soul sickens. So long as the soul re. mains incorporated with man, so long will it partake of his nature, according to hts attributes." And again, u The diseased manifestations of the mind, arising from terror, grief, excess of joy, remorse, shame, loss of property, and despair, prove the sensibility of the mind, though they betray its weakness* To deny the influence of those contending passions, would be, in some respects, to stifle principle, and to sink man below the level upon which Omnipotence had thought fit to place him. If the mind never sickens, conscience, the great inquisitor and monitor of man, would prove of no avail. Yet, this conscience, this mind, this soul, 6f man, is but too often most sorely afflicted. It encounters disease with a mighty struggle, and is sometimes triumphant. If the wound be de&p^ however, it will * fall sick;' and with this sickness will come death. * The spirit of a man will sustain his infirmity; but a wounded spirit who can bear ]' (Proverbs, ch. xviii. v. 14.)" This is such utter and irrelevant nonsense, that we 4lmo& criminate ourselves for having thought the author's arguments on this subject worthy of our notice. But, as we have commenced, we will proceed: ? " The mind is capable of impressions which evidently d&tfirb its natural functions: it will continue thus disturbed for a series of years, and not impart any ostensible disease to the organs of life; it will be partially or generally affected, and will frequently, without any strong effort, resume its original character." Those impressions (corporeal, of course ; or, if not, what can they possibly be?) which disturb the natural functions of the mind, are disordered, or diseased, impressions. JNo action that destroys the harmony of the economy can be considered as an healthy action. That insanity exists for a series of years, without producing " any ostensible disease in the organs of life," is very doubtful. But this is not a point of material importance, because it is well Ascertained that functional derangement, es-222 Critical Analysis. specially deranged circulation, will exist in the brain for years#: without dissection furnishing ostensible disease.. We can point out sufficient proof of this fact, and at the same time direct the attention of the reader to an excellent practical work, by referring to Dr. Parry's Elements of Pathology. ^ We will not argue on the absurdity of supposing that au immaterial existence can be partially diseased, and have efforts in itself by which it diseases itself, and then by an effort restores, itself to health. We wish to consider the subject physiologically.
Dr. Hallaran proceeds to say, " If the mind, under those circumstances, be not diseased, how arc we to account, for the relief which has been so repeatedly obtained, through agencies that cannot be supposed to influence any other than the perverted powers of the intellectual faculties ?" The influences to which the author here alludes are moral influences, which act on the mind through the medium of the brain, and may casually relieve the disease of the brain causing diseased manifestation of the intellects, just as the same influences will remove the disease of the brain, causing epilepsy, and even lesions in die functions of more remote parts, appearing as chorea, hysteria, ague, &c.; instances of which occur almost daily to the observance of the physician. A remarkable instance of this kind is that which Boerhaave relates of his curing, simultaneously, a whole troop of young girls, in an orphan asylum, affected with epilepsy, by threatening to burn them if the fit again occurred, and exposing the red-hot iron to their view. The great excitement thus produced in one portion of the brain, may probably remove that existing in another, as caute-'ries, &c. do diseases of parts adjacent to those to which they are applied, or those distantly situated, by sympathetic or nervous influence.
Dr. Hallaran, pursuing his course, adduces the following case in support of his hypothesis: " Mental delusions, inciting to suicide, have often occurred, and,, to my knowledge, are now in danger of occurring, where no bodily infirmity has been ever ascertained to account for such a propensity. The present justly-celebrated Dr. Gregory, of Edinburgh, was accus. tomed to relate a case, in his clinical lectures, very much in point, of a man, who, in a fit of insanity, had determined on self-destruction ; and who had escaped from his house in London, at night, with the determination of precipitating himself from Westminster-bridge into the Thames. When about to complete his purpose, he was suddenly assaulted by an armed footpad, who threatened him with instant death. This not being the mode by which he had purposed to part with life, alarm for his safety instantly seized him, to the exclusion of the hallucination which had been but the moment before predominant. Being Dr. Hallaran on he Causes and Cure of Insanity. 223 freed from his unsought danger, he, with altered sentiments, returned to his family, fully impressed with the criminality of his design, as well as relieved from the pressure of his previous perplexity. " Are we, frota this well.authenticated fact, to infer that the indi. viilual alluded to had been, at the time of so sudden a transition from disease to health, a sufferer from the consequenccs of mere corporeal ailment ? What form of bodily complaint could have been urgent, which, with such unexampled rapidity, was disposed to give way ? We do not in general find diseases, arising from organic lesion, disposed to assume the healthy aspcct with this convenient speed. The initid, we must here admit, had sickened, and was diseased." , The remark we made respecting the cure of epileps}', will also explain the nature of this case; and though " diseases arising from organic lesion are not disposed to assume the healthy aspect with this convenient speed," diseases arising from luactional derangement are thus commonly relieved ; especially in the brain, where a little inordinate vascular action will produce great disturbance of its faculties. As we like to support our opinions by those of others, we refer for proofs of this statement to a work in the possession, we hope, of every medical student, ?the Elements of Pathology, of Dr. Parry.* " The sequel of this case," (of the man who intended to drown himself,) says Dr. Hallaran, " enforces the conclusion, no proof of corporeal or organic injury had been alleged." We allege again, that the existence of insanity was a proof of organic injury; and the want of evidence of this injury by other symptoms proves nothing, because it is so common to meet with organic lesion in the brain when it has not been suspected by every physician.
We have noticed all that the author has produced, bearing the semblance of argument, in favour of his hypothesis of the " mental origin" of insanity: we shall now extract a passage from his work, in which he himself refutes his own propositions. " Doctor Spurzheim admits, that' certainly the manifestations of the mind may be deranged.' Those manifestations I am disposed to consider as the essence of the mind at the time being. If the manifestations of the mind be diseased from any given cause, they naturally must betray an unsound mind, in the ordinary acceptation." Now, if the manifestations of the mind be the essence of the mind, (" at the time being" is a vague and unmeaning expression, because the essential quality of a thing is its quality at all times and on all occasions,)?the essence of the mind must b? ? We must here remark, that we speak with such approbation of this work, because of the multitude ofaccurate observations it contains relative to the phenomena of disease : these are equally valuable, whatever opinion may be held of the physiological basis on which the doctrine contained in that work is raised. ) 224 rj " Critical Jnalj/sfs,, ,q c6rporeal actions, for every physiologist mugt acknowledge that such actions essentially constitute the manifestations of the mind; then, as a postulate, a deranged mind consists essentially in deranged corporeal actions; and the profound deduction ! that diseased actions betray diseased actions, no one will oUje<tt to. This is the author's doctrine, not our's: we are not such confirmed materialists.
We but rarely find persons give so ill an exposition of their own doctrines as Dr. Hallaran has done of his on the nature df insanity. We in general see them, after eight years' reflection, able to attribute a plausible character to principles almost as chimerical as those forming the basis of this work. Bijoux, a keeper in the menagerie at the Jardin des Plantes, who formed a classification of animals from the shape and colour *>f their excrements, could make a very profound and logical oration on the merits of his system, and it was quite impressive to hear the ingenious arguments he would produce to show its propriety ; but, what is very extraordinary, and indeed unprecedented in the ann&ls of science, he died (poor fellow f) without leaving behind him an apostle, to teach and perpetuate the knowledge of his discoveries.
Although we were to join Dr. Hallaran in his Jamentatiobs over neglected psychology, we could not recommend the results of bis labours, to vindicate its cause, to the attention of pur readers: in the want of all the existing dissertations by ancient and modern physicians, we would rather study the Alma of Prior ; there is in that at least as good logic, and certainly much better physiology, than in the treatise of Dr. Hallaran.
The work of Dr. Hallaran, then, we observe with regret, tends much to favour the progress of pure empiricism : it shows that, Without correct physiological principles, a person may in some cases be a good medical practitioner ; for, the lunatic asylum over which he presides, is remarkable for the great proportion of cures, (especially when the causes of the disease in a great number of the patients therein admitted are considered,) effected within its walls; and we know that the moral and medical management, is there conducted with great propriety, so, indeed, as to be strikingly evident, in the former respect, to the patients themselves when convalescent.
If wc were to indulge in a particular account of that part of the work which relates to the treatment of the disease, we should have much to notice with terms of warm approbation; we here find the remarks and precepts of a good practical observer, and feel increased regret that the assumption of erroneous psychological and physiological principles, should have led the author into the erroneous reasoning contained in the part of the work that has passed our particular review.
Dublin Hospital Reports, He. 215 * We must however describe the arrangement of the subjects* which 19 good in a practical point of view. Dr. Hallaran con? siders, in order, the general and local causes of insanity ; its hereditary nature; the prognosis in its various forms; the method of cure in general; and then the particular remedies, as venesection, local blood-letting, emetics, purgatives, the circular swing, digitalis, opium, camphor, restraint, vesicatories, mercury, warm and cold bathing; the treatment during convalescence, and in the chronic form of the disease; the efficacy of spirit of turpentine in maniacal epilepsy; and he concludes with some reflections on the moral management.
Those subjects are treated with much precision, and with a spirit which shows the man of good talents, especially of aciltfe observance* The knowledge of the results of the author's ex-, periqnee will be of great; utility to those who are particularly interested in the acquisition of information respecting the: treatment of this disease. For the illustrations of these remarks we refer to the work; an abstract would not place them in a proper poirit of view. This disease usually occurred in men between the ages of twenty and forty; Dr. Colles only saw one instance of it in a Female. It appeared in the form of a chronic bubo, arising without apparent cause, suppurating very slowly, and remaining open for several months, attended with but very little pain.
The remarkable symptoms were the constitutional affections.
(i Fromi the very earliest period at which I have had an opportunity of observing this complaint, the constitution is found to be engaged. The patient is affected with head-ach, which is more severe in the morning, and which is increased by stooping: he also admits, when questioned, that he feels more fatigue than usual from long-continued Or violent exertions; his pulse is quick, being in no case, when he is out of bed, under 100, and generally beating 120 in the minute. This quickness of pulse appears the more extraordinary, as it is obviously not produced by a high degree of pain, nor is it accompanied by ai discoverable derangement of any other of the functions: on the con* trary, the countenance is natural, respiration easy, skin of temperate heat and not very dry, tongue clean, appetite as good as usual, anil No. 247. 2 G 226 c Critical Analysis. scarcely ever nocturnal sweats.: The patient) however, feels liiitiSclf more comfortable in the open air than when confined to the house. r t( In the treatment, 1 have confined myself to those means which I have conceived to be calculated to mitigate the severity of the symptoms, and to promote suppuration, which indeed seemed to be generally an unavoidable, and always a salutary, termination of the disease.
The head.ach appeared to be alleviated by no class of medicines but by purgatives. These were repeated every day, or every other day, until this symptom was completely removed: very large doses were often required to produce the desired effect. The removal of the head.ach was not attended with a diminished frequency of the pulse.
Poultices, warm fomentations, and gum-plaisters, were the only topicat applications to which I had recourse. Leeches had been applied, in two instances, before I saw the patients, but apparently without any1 salutary effect. Cold and (as they are termed) repellent applications, when used for a few days in the earlier stages of the disease, did not appear to produce either benefit or injury." An Account of an uncommon Disease of the Hand and Fingers. By C. H.Todd, Member of the Royal College of Surgeons in Ireland, &c.
This paper contains some observations of remarkable interest; and Mr. Todd has viewed the subject in so accurate and judicious a manner, that we shall transcribe his account of the nature, and his opinions respecting the origin, of the disease to which they relate.
<{ As far as I have observed, this species of whitlow occurs only in persons who have passed the meridian of life, and in such as are weak and unhealthy. It is preceded by symptoms strongly indicative of great debility, and of a want of energy in the functions of assimilation. Patients complain for several days of loss of appetite, of flatulence, thirst, and irregularity of the bowels, depression of spirits, and watchfulness ; then the local affection takes place, and is most commonly felt at night for the first time, the patient's restlessness being increased by stinging pains in the fingers or hand. At this period small red or livid spots, without hardness or elevation, may be observed, which soori become black. The sensation in the part is between soreness and itching, and the patient is induced to rub or scratch it: this accelerates vesication, the cuticle becomes detached, and a thin and offensive sanies is effused under it.
When the vesicles are removed, the subjacent skin appears sphacelated, and superficial ulcers are discovered ; the disease showing a disposition to extend by destroying the surface merely. At first, local pain is severe; but in a few days it is not much complained of, and the absence of pain is to be considered rather as a cause of alarm than the contrary. Several parts of the fingers and hands are liable to be attacked by this disease in succession; and it often happens that, when one part is nearly well, another will become, affected. This must be cxpccted in any case in' which general indisposition continues.
Dublin. Hospital Reports, Kc. 227 : " During the entire progress of this disease the patient labours under a low fe?er; sometimes this fever does not require confinement to bed, but in many cases it is serious, and is liable to assume a typhoid character. In every instance the functions of the stomach and bowels are imperfectly performed, and all the secretions are diminished: las. situde, mental depression, and anxiety, are among the symptoms most distressing to the patient and to the persons around him. " The treatment necessary for a disease such as the paronychia gangrenosa appears to be, is so obvious, as to render a minute detail of ft at present quite superfluous. However, I may observe, that in this affection our practice must be chiefly directed to counteract constitutional disease and weakness, and to improve the condition of the organs of digestion. Unless these objects are attained, our patient will, in all probability, sink, not under the effects of local irritation, but in eonsequence of that highly morbid state of the system, of which the topical affection is solely an indication. Before the disease appeared to me in this light, I met with two or three fatal cases of it, in which the affection of the fingers was not of an extent sufficient to account for the unfortunate termination of the complaint. Indeed, I never saw an instauce in which the severity of constitutional indisposition could be explained by the local symptoms." The author relates several cases, which seem to show the truth of his opinions; which are also, in no small degree, supported by our knowledge of the functions and connexions of the ganglionic system of nerves.

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These observations were made on the bodies of children who died in one of the. fever-hospitals of the House of Industry. We transcribe the following passage, as containing some remarks of great practical interest: " That the epidemic has throughout shown a strong tendency to attack the digestive organs, chiefly in their mucous coats, is fully ad. mitted by most persons who see those fevers on a large scale : it has been sufficiently insisted on by Dr. Cheyne in his report, and an atten. tionto this point tends to improve the practice in fever* where the ?pigastric distress is present. It shows that we should not confine our views merely to the sensorium, as some have done, but that we should extend them to other organs. Of the distress in these latter, the symptoms will often afford sufficient evidence, but the examination of those who die of such fevers will frequently put the matter beyond a doubt: indeed, the diseased appearances vny so much in those who .die from fever, that it is natural to conclude that no particular mode of treatment can be equally suited to fevers, as they occur attended by topical affections in different organs. The lancet and smart purga. 2 g 2 22& Critical Amlyt45. " \ tires, so iis4flul in ccrtain forms Of , incipient fever, are by-no trieafns equally suited to such as are attended with gastric and intestinal distress, except in those instances where the serous membrane of the abdomen becomes inflamed,?an occurrence which may take place at any period 5 and then it will be necessary to haye recourse to general as. well as local sanguineous depletion." < .
Jt should however be observed, that Dr. John Crampton* t^iirrks it by no means clear, that the appearance forming the express subject of these observations, should, in every instance, be considered as the cause of the form of fever which happened to be present: it accompanied the epidemic of the season, it. likewise attended the small-pox, and it was observed, in some instances, independent of any febrile disorder. The appearance, te remarks, was similar to that described by Dr. Baillie,, under the head of dysentery ;* a description of it will be found also in MoRGAGNi,f and in the Transactions of fhe Berlin.
Medical Academy.t This paper contains many judicious remarks on the imports anco of attending to a subject much neglected in this country, ?the state of the mucous membranes in febrile disorders; andy had not this b^en so extensively treated in the Exposition of the Doctrine of jVI. Broussais, we shpuld have been disposed tQ adduce several extracts from the valuable memoir of Dr. John Crampton. This was. an instance of a pistol-bullet entering the cavity of the cranium. When the immediate consequences of the injury subsided, the patient continued tolerably well for about sij$ jponths,; but symptoms of irritation of the brain then appeared, and he died about seven weeks afterwards. The following ig the account of the appearances on dissection : " Directly opposite the sinus in the scalp, there was a perforation iu the ps froutis, sufficiently large to admit the point of the little finger, and a groove in the external surface of the bone leading towards the wound, which had been made for the extraction of the balk " The internal spine seemed as if it had been broken, pushed aside, and had again united; for the bone was extremely rough, spiculated* and prominent in this part. Dublin Hdspital Reports, ttc.
?2Q *?' Thedwra roatcr, through which there was an opening corresponding with that in the bone, was morbidly adherent to its margin. The, pia mater was also pierced, and closely united to the dura mater) in; the vicinity of the sinus, which led to an abscess in the left hemisphere of the cerebrum, containing something more than an ounce of pus, and a large ragged portion of a bullet. " There were several pieces of bone within the substance of the brain at different distances from its surface, and some had passed altogether through it, and lay below the hemisphere. The ventricles contained upwards of a pint of fluid. The remainder of the brain was remarkably firm, and free from all appearance of inflammation.'* A Case of Disease of the Gums, which occurred during Pregnancy. We discern nothing sufficiently interesting in this case to merit any particular remark. The patient of the first case was a man, aged 26 years, who fell in walking whilst the bladder was distended with urine.
The usual symptoms of the effects of extravasated urine ensued, and he died eight days after the accident. An opening was made in the abdomen on the third day, to give vent to the diffused fluid. The appearances on dissection were signs of severe and general inflammation of the peritoneal membrane. The bladder was found ruptured on the right side, a little posteriorly, to the extent of an inch in the contracted state of the organ.
In the second case, a man aged 30, it is remarkable that the bladder had been evacuated a short time before the accident: the patient fell from the battlements of a bridge, about twenty feet high, to the ground, and he himself stated, oil his feet. He died on the ninth day. The bladder in this case was ruptured almost in the same situation as in the preceding case, and to the same extent. This case is interesting as an instance of metastasis of disease froin one part to another of similar structure. The patient, a woman aged 28, had severe inflammation of the synovial membranes of the knee-joints, which was almost totally relieved by venesection, leeches, &c.; but, after the lapse of a few days, the patient was seized with inflammation of the peritoneum, which, 230 ? Critical Analysis, notwithstanding the use ot bleeding, &c, rapidly terminated in death. ? Dissection showed signs ot violent inflammation over the whole extent of the peritoneal membrane; there was also much coagulated lymph on the inner surfaces of the synovial membranes of the knee-joints.
Mr. M'Dowel calls the disease rheumatism, and on this foundation adduces objections to the opinions generally admitted 6n the nature and seat of that affection; but we shall not uselessly occupy our pages by remarks on these ill-founded speculations.
It should however be mentioned, that the remedial measures employed appear to have been appropriate; except that, in a pharmaceutical point of view, it was wrong to mingle tartarized antimony with decoction of cinchona; and we cannot discern what were the intentions in giving such a combination of the materia medica. The patient, a woman about 45 years of age, took, from ac-cident^ a solution of nearly two ounces of oxalic acid : almost immediately afterwards she was attacked with vomiting, and complained of a burning heat in her stomach ; she had an evacuation by stool, and passed urine ; her face and extremities soon became pale and cold, and the skin was partially bedewed with a cold sweat; she vomited almost incessantly; and expired in about twenty minutes.
The patient had experienced an injury on the right side of the chest, a few days previously. Besides signs of inflammation, the following appearances were witnessed, which may perhaps be connected with the agency of the poison ; " The right auricle and ventricle of the heart were considerably dis# tended: on puncturing the auricle a quantity of air escaped, and the heart immediately collapscd. The blood contained in these cavities was dark and fluid, and had a number of air.bubbles floating on its surface. The parietcs of the ventricle were thinner than common, as if they had undergone considerable distension. The left ventricle was less contracted thau usual, but in every other respect was perfectly